| NPI | 1992218036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSYC.00015400) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 174H00000X Health Educator | |
| Enumeration Date | 2017-11-11 |
| Last Update Date | 2024-07-29 |